The growing cohort of seniors with HIV/AIDS: changing the scope of Medicare Part D

Abstract

HIV/AIDS medications are generally expensive and government assistance is often necessary to limit high out-of-pocket patient costs. Lowered patient out-of-pocket costs were the objective of government involvement in drug provision through legislation creating Medicare Part D. However, the Medicare program faces a surge in those beneficiaries living longer on more effective antiretroviral drugs. Higher prevalence of HIV/AIDS patients means more opportunity for transmission of the infection and recidivistic behavior such as non-adherence to medication regimens. Along with the resulting increased frequency of opportunistic infections in HIV/AIDS patients comes the requirement for aggressive pharmacological treatment. To meet this need, Medicare Part D provides drugs for the treatment of opportunistic infections occurring in HIV/AIDS patients. Problematically, though, Medicare Part D contains so many choices that it tends to overwhelm patients and sometimes even the providers and insurance companies as well. The multiplicity of choices in this highly complex program for the aged and infirm often leads to confusion and incorrect choices by beneficiaries. Furthermore, the advent of tiered cost-sharing or formulary management by Medicare Part D providers, besides controlling out-of-pocket costs, controls which medications are covered and limits the quantity that is dispensed. HIV/AIDS treatment in the present day requires a highly accessible medication provision program that is only now beginning to evolve as Medicare Part D.

Keywords:

• Medicare Part D
• HIV/AIDS
• ARV/HAART
• opportunistic infections
• cost-sharing tiers